And How to Find the Right Rehab, if it is Necessary

By Julie Myers, PsyD, MSCP

It is my opinion that most people with substance abuse or dependency issues can recover with outpatient treatment from a licensed mental health professional or with the support of self-help groups. However, in some cases, a Residential Treatment Center (RTC) may be necessary.

A licensed mental health professional, such as a psychologist certified in addiction treatment, can formulate an individualized treatment program equal to or better than many programs offered by “rehabs”. A psychologist can provide individualized care to help identify behaviors and emotions that drive substance-using behaviors and can treat any underlying mental health conditions that likely exist. Competent professionals can formulate an integrated, comprehensive program, which can include psychotherapy and referrals to psychiatric care, self-help meetings, group therapy, sober living homes, and other alternative treatments modalities. The notion that everyone with substance abuse problems needs residential treatment is as unreasonable as stating that everyone with depression needs hospitalization.

Although outpatient treatment is preferable and sufficient for most people, there are those who may need a higher-level of care than outpatient treatment can provide. In particular, some people may need a more restrictive environment, where there is no access to drugs or alcohol. Sometimes, when a person is actively using and can’t stop, a Residential Treatment Center can provide the respite that a person needs from their access to drugs or alcohol. They may also be indicated for those with severe forms of co-occurring psychiatric disorders that have not been adequately stabilized.

However, RTCs can vary greatly in their quality and level of care. Some offer comprehensive, “gold standard” care, with evidence-based practice from qualified treatment professionals. Others may offer little more than restrictive use of substances. So the question becomes, how does one choose a Residential Treatment Center? It may be difficult to determine which is the best RTC for themselves or their loved-ones, because they may not know the right questions to ask, and because many RTCs may be vague about what their programs include.

It would be helpful to have a set of key questions that someone seeking treatment could ask of the RTC about their program. Recently, Dr. Donald Meichenbaum shared a letter with me, which he drafted for those seeking residential care. This letter can be sent to the Director of an RTC that a person is considering. This letter asks questions about the RTC’s program, questions that can help the consumer make an informed decision about that facility. I have reposted his letter on my website, which you can find at http://www.DrJulieMyers.com. I believe that this letter can help guide the consumer to find a residential treatment center that is right for them, should they need that level of care.

There has been a call for alcohol programs to broaden the base of alcohol intervention, reaching out to those who do not normally seek treatment (Tucker et al., 1999.) By offering programs targeted to nondependent drinkers and by using electronic media, those who do not normally seek treatment may be included. In this study, Humphreys and Klaw surveyed members of the self-help group known as Moderation Management (MM) to determine if the group has reached this underserved population.

Moderation Management is a non-12-step based self-help group, which helps those who wish to moderate their drinking. Although there are other non-12-step based sobriety programs – such as SMART® Recovery, Rational Recovery, and Women for Sobriety — the authors claim that MM is the only self-help organization to target nondependent problem drinkers and to allow moderate drinking rather than abstinence.

The authors examined the characteristics of members of the group through survey self-reports. The survey included demographic characteristics, alcohol consumption patterns, life functioning, religious tendencies, and participation in other self-help groups. It also explored the participation in the group via internet-based resources to determine if members in these groups differed from members involved in face-to-face meetings. 177 surveys were returned, which represented a large proportion of surveys given out in face-to-face meetings and an unknown proportion of electronic surveys.

The results showed that those in MM tend to be white, employed, college educated, not strongly religious, and early middle-aged. Those returning the online surveys were more likely to be female, more educated and atheistic, and have greater markers for dependency. Few respondents were likely to have other drug dependencies. Overall, MM does not attract those who are highly dependent, who would more likely benefit from an abstinence approach. For those who attended online meetings, their stated reason for using the electronic resources were its availability and ability to access the resource at any time of day, the privacy afforded, and because they found it easier to write about their feelings than speak about them.

This study brings to attention the need for and availability of alternative alcohol self-help groups. However, the study was clearly limited in its ability to conclusively determine characteristics of the self-help group members. This was largely due to the experimental design, which used self-report measures. Also, the surveys returned clearly biased the results in favor of those who were highly motivated to return the surveys (or who really needed the $20 payment!) It is likely that those who were more highly educated and who preferred writing about their problems were more likely to complete the survey. It would be interesting to conduct a survey with a randomly selected sample population, something unlikely with such a small organization of voluntary members.

In my opinion, the authors did not seem particularly knowledgeable about other self-help groups, often misrepresenting them. They state that other self-help groups have claimed a “niche” market. SMART® Recovery, for example, is a broadly-based group that includes members with a wide variety of addictive behaviors and socio-economic backgrounds. The only niche that I see in this group is that it is not Alcoholics Anonymous (AA). The authors also include Rational Recovery in their discussion of self-help groups, even though they have not existed as a self-help group for some time and are not abstinence based.

The authors propose that one reason that more women use the online self-help group than men is because men may be more dedicated to abstinence. This is highly speculative and does not seem very well informed, in my opinion. There are many more plausible explanations for this, including the greater likelihood that women completed the survey and the social climate of AA, which is the most well attended abstinence based self-help group. Women are more likely to have a strong social network then men, thus they are less likely to rely on a self-help group for social contact; men tend to have fewer social contacts, especially those that do not use alcohol, and thus may seek out the social support of AA. A random sample would help tease this out.

Also, I believe that men are more likely to receive court-appointed treatment than women, thus they are more likely to be mandated to abstinence-based programs. As far as I know, MM does not comply with court mandates for treatment. Mandated treatment is a significant reason why people attend self-help groups. It would be interesting to ask members why they are attending treatment in further surveys. It would also be interesting to ask if their ultimate goal was abstinence.

The authors stated purpose was to explore how services could be tailored to non-dependent drinkers and to those wishing to use the internet. It would have been interesting if the authors speculated about how this group could have been tailored to meet that need. Given the data collected, how could MM attract more members or a more diverse group of members?